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Article 2 |
The Insurer shall pay personal injury medical expense benefits only for necessary and reasonable relevant medical expenses actually incurred to the injured party in respect of his/her bodily injury suffered in an automobile traffic accident. The total of personal injury medical expense benefits is limited to NT$200,000 per person in any one accident.
The relevant medical expenses referred to in the preceding paragraph shall cover the following expenses:
1. "First-aid expense" means the expense for salvage search, ambulance and ambulance man.
2. "Expense for medical treatment" means:
(1) The injured party receives the National Health Insurance coverage:
A: The payment subject to the Rule of National Health Insurance Payment for Medical Care, the expense for outpatient treatment.
B: The Non National Health Insurance Payment : Only for ward expense, registration fee, medical certificate fee, meal expense, deductible expense for material and installation of artificial limbs, teeth and eyes paid by the injured party, and any other expenses for medical material (supplementary equipments included) and other protective tools necessary certified by medical doctors.
(2) The injured party doesn't receive the National Health Insurance coverage: The medical treatment expense can't exceed the emergency expense, the average day payment of clinic or hospital standard regulated in the Regulations for NHI Reimbursement of the Self-advanced Medical Expenses Connected with Emergency Injury/Illness. If the injured party can provide the whole medical expense fits the National Health Insurance items and standards, all the medical expenses shall apply mutatis mutandis to the NHI Payment Standards.
3. "Transportation expense" means the reasonable transportation expense for round-trip, transfer, or leave from a qualified hospital or clinic.
4. "Nursing expense" means the expense for special nursing or nursing in hospitalization due to severe bodily injuries. But the necessity for home nursing must be certified by a qualified medical doctor.
The payment of expense for medical treatment referred to in subparagraph 2 of the preceding paragraph is limited as follows:
1. Deductible for ward expense: It means the injured party received hospitalization in a qualified hospital or clinic, and NT$1,500 per day.
2. Meal expense: It means the injured party received hospitalization in the former subparagraph, and NT$180 per day.
3. Deductible expense for the material and installation of artificial limbs: NT$ 50,000 per upper limb or lower limb.
4. Expense for the material and installation of artificial teeth: NT$10,000 per tooth and NT$50000 if more than 5 teeth.
5. Expense for the material and installation of artificial eyes: NT$10,000 per eye.
6. Other expense for necessary medical material (supplementary equipments included) and other protective tools: NT$20,000.
Round-trip transportation expense from a qualified hospital or clinic referred to in subparagraph 3 of the paragraph 2 is limited to NT$20,000.
Nursing expense referred to in subparagraph 4 of the paragraph 2 is limited to NT$1,200 per day and up to 30 days.
After the injured party receives the benefits provided by the National Health Insurance, the insurer of the National Health Insurance may subrogate the right of the injured party to recover the expenses against the insurer of this insurance, subject to Article 82 of the National Health Insurance Law. But the amount of subrogation is limited to the balance of NT$200,000 deducted by the benefits of this insurance to the claimant.
The payment for bodily injury medical expense by the Compensation Fund, subject to this Act, does not include the benefits provided by the National Health Insurance.
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Article 4 |
In the case that the injured party suffers bodily disability because of an automobile traffic accident, the insurer of this insurance shall examine the claim in accordance with the following rules:
1. If the disability of the injured party fits any one item in the attached handicapped payment standards table, the benefit shall be paid in accordance with the level of such item.
2. If the dismemberment or disablement of the injured party fits any two or more items in the attached handicapped payment standards table , the benefit shall be paid in accordance with the highest level among such items, except for the situation provided in the below subparagraphs.
3. If the disability of the injured party fits any two or more items from Level 14 to Level 1 in the attached handicapped payment standards table, the benefit shall be paid with one level higher than the highest qualified level. If the highest level is Level 1, the benefit shall be paid with Level 1.
4. If the disability of the injured party fits any two or more items from Level 8 to Level 1 in the attached handicapped payment standards table, the benefit shall be paid with two levels higher than the highest qualified level. If the highest level is Level 2 or above, the benefit shall be paid with Level 1.
5. If the disability of the injured party fits any two or more items from Level 5 to Level 1 in the attached handicapped payment standards table, the benefit shall be paid with three levels higher than the highest qualified level. If the highest level is Level 3 or above, the benefit shall be paid with Level 1.
6. If the benefit payable in accordance with subparagraphs 3 to 5 shall exceed the total amount of respective benefit items, the total amount shall be the final payment.
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